Every pediatric endocrinologist knows what “Tanner staging” is and how to do it but I am amazed that many of my younger colleagues do not know who or what the word “Tanner” stands for. In fact, Tanner staging is named after James Mourilyan Tanner, a distinguished English pediatrician who died on August 11, 2010 at the ripe old age of 90 years. I had the honor and pleasure of having knowing Dr. Tanner whose contributions to pediatric endocrinology were enormous. Tanner staging is a method developed by Dr. Tanner to describe in a series of steps, the progression of sexual maturation in males and females from pre-pubertal (Tanner stage 1), to full adult sexual maturation (Tanner stage 5). Thus, Dr. Tanner developed a method to grade the level of sexual maturation for breasts in girls, pubic and axillary hair in boys and girls, and genitalia (testes, scrotum, and penis) in males on a scale of 1-5. Of course, to develop such a scale, Dr. Tanner first had to study the course of adolescent sexual development in a large number of girls and boys. Dr. Tanner did this as part of his work in overseeing a long-term study of malnutrition in a large group of British children living in an orphanage in Harpenden England. Not only did his work result in a method for characterizing a child’s level of sexual maturation, his work also led to the development of modern-day growth charts, so indispensable to growth assessment.
So, when you see a clinic note on a 10 year old girl in which the physician has written “breast development was early T2 while pubic hair was T 3” you can be sure every pediatric endocrinologist (and pediatrician) knows just what that patient’s pubertal status is. None of this would have been possible without Dr Tanner’s meticulous data collection month after month and year after year in the Harpenden orphans.
Dr. Tanner was one of the first pediatric endocrinologists to use human growth hormone and I remember well a lecture he gave many years ago, long before recombinant DNA-derived growth hormone was available. He lamented just how difficult it was to be certain that a patient did or did not have growth hormone deficiency; at the time, he estimated that even in “classic” cases, we over-diagnosed growth hormone deficiency about 30-40% of the time. Personally, I don’t think we do even that well these days despite all the fancy new growth factor tests (e.g, IGF-1, IGFBP3)!
I also remember how he used to talk about the importance of careful measurements. He lectured and wrote extensively on the proper way to measure children. Along with another Englishman, Reginald Whitehouse, he promoted the use of stadiometers for quantifying height in children.(a stadiometer is a fancy yardstick, perhaps more properly called a meterstick, with a counterweighted head board and a counter for direct reading of the height. A well-made stadiometer is expensive, but essential if one is to obtain reliable height measurements).
Anyway, for you younger pediatric endocrinologists out there, next time you carry out a physical examination in a child or adolescent and you do Tanner staging (which of course is a routine part of most every physical examination performed by a pediatric endocrinologist) , remember who to thank for the sexual staging system.
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